1. Home
  2. Program Models
  3. Washington State Hub and Spoke Model

Washington State Hub and Spoke Model

A statewide treatment system to expand the availability of all three forms of medications for opioid use disorder

The Washington State Hub and Spoke Model, administered through the Division of Behavioral Health and Recovery at the Washington State Department of Social and Health Services and funded by SAMHSA, is a replication of a successful hub and spoke model in Vermont. It is a model for a statewide treatment system to expand the capacity to deliver medications for opioid use disorder (MOUD), which include methadone, buprenorphine, and extended-release naltrexone. 

Taking into account that individuals with opioid use disorder (OUD) seek treatment in a variety of settings, employing the model of a central hub with extending spokes has the potential to engage more people in evidence-based care. Hub sites identify, collaborate, and subcontract with spokes to provide integrated care with medication treatment, regardless of how participants enter the system. There are currently eleven hubs across the state that are each connected to numerous spokes. Some of the more non-traditional spokes include prisons, jails, jail release programs, drug courts, probation, and police and fire departments, increasing the touchpoints were individuals can more readily access MOUD.  

The Washington State Hub and Spoke model differs from other models to deliver MOUD because the hub can be any organization that has MOUD expertise and capacity to manage the network, whereas the Vermont and other hub and spoke models use addiction treatment providers as the hub. As a result, three of the networks had some form of primary care provider as the hub. The Washington model also includes a nurse care manager as a key element, drawing from the Massachusetts model.

More information on the hub and spoke model can be found in the news articles here and here. More detail on how this model deliveries MOUD can be found in the peer-reviewed paper here. The model is currently being evaluated by Brandeis University. See the presentation here for an overview of Washington State's response to the opioid crisis.

In addition to Vermont and Washington, California has also implemented a hub and spoke model, which has shown preliminary success. 

In the first 18 months, nearly 5000 people were inducted onto OUD medication treatment....73% on buprenorphine, 19% on methadone, and 9% on naltrexone.

Continuum of Care
Treatment
Type of Evidence
Peer-reviewed
Replicated
Response Approach
Medications for Opioid Use Disorder
Peer-reviewed Article
The Washington State Hub and Spoke Model to increase access to medication treatment for opioid use disorders
Related Resources
Medications for Opioid Use Disorder Save Lives
Medication-Assisted Treatment With Buprenorphine: Assessing the Evidence
Medication-Assisted Treatment With Methadone: Assessing the Evidence
Medication-Assisted Treatment Models of Care for Opioid Use Disorder in Primary Care Settings
Primary Care–Based Models for the Treatment of Opioid Use Disorder: A Scoping Review
Primary Care: On the Front Lines of the Opioid Epidemic
Barriers to primary care physicians prescribing buprenorphine
Aligning City, County and State Resources to Address the Opioid Epidemic: Lessons Learned and Future Opportunities
Review of State Strategies to Expand Medication Assisted Treatment
The Fentanyl Epidemic: State Initiatives to Reduce Overdose Deaths

Evidence of Program Effectiveness

"Six hub-spoke networks were funded, with 8 unique agencies on average, and multiple sites. About 150 prescribers are in these networks (25 on average). In the first 18 months, nearly 5000 people were inducted onto OUD medication treatment: 73% on buprenorphine, 19% on methadone, and 9% on naltrexone...The Washington State Hub and Spoke Model built on prior approaches to improve the delivery system for OUD medication treatment and support services, by increasing integration of care; ensuring “no wrong door” by increasing access to medication treatment in a variety of service settings where people with OUD may first appear (e.g., mental health agencies, primary care) rather than requiring direct contact with an OTP or specialty SUD treatment provider; engaging with community agencies; and supporting providers who offer medication treatment." (Reif et al., 2019)